Effective October 1, 2025, American Specialty Health^® (ASH), a Cigna Healthcare^® national ancillary provider, will begin managing the medical necessity review of outpatient hospital sites of care for Cigna Healthcare–contracted providers who render physical therapy and occupational therapy (PT/OT) services for patients with Cigna Healthcare commercial plans and Individual & Family Plans.¹ ASH will also be responsible for medical necessity review of requested PT/OT services.

Medical necessity review will ensure coverage is received at an appropriate site of care, such as at a freestanding PT/OT facility (when available), unless an outpatient hospital setting is medically necessary.

How the medical necessity review process works

• If a provider determines after the initial covered assessment/visit that the patient should continue receiving PT/OT services in an outpatient hospital setting, the provider will submit a medical necessity review request to ASH for approval.
• ASH will approve an outpatient hospital setting when it is medically necessary, as defined in the Site of Care: Outpatient Hospital Setting for Physical and Occupational Therapy ‒ (0600) medical coverage policy.
• Medical necessity review request decisions will typically be made within one business day of receipt of all necessary clinical information.
• If ASH determines it is not medically necessary to continue PT/OT services in an outpatient hospital setting:
  • An ASH concierge team member will outreach to the patient to identify in-network PT/OT locations or virtual service options.
  • A letter will be mailed to both the provider and patient within one business day explaining the decision.

For information on the PT/OT services for which medical necessity review will be required, please refer to the Site of Care: Outpatient Hospital Setting for Physical and Occupational Therapy ‒ (0600) medical coverage policy.

Training opportunities: September 15 to November 5, 2025

To join a meeting, scan the QR code or go to the ASH Site of Care website. The complete meeting schedule is also available on the website.

Live training sessions will be conducted via Microsoft^® Teams^®. Preregistration is not required.

Training will be recorded and accessible for those who cannot attend a live session.

Contact information

1. Implementation for Individual & Family Plans is dependent on state regulatory requirements.